HTHSCI 2F03 Lecture Notes - Lecture 8: Opioid, Chronic Pancreatitis, Biliary Colic
26 Dec 2020
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Gallbladder spasm against a stone impacted in the neck of the gallbladder hartmann"s pouch. Less commonly, the stone may be in the cbd. Ruq pain radiating back (scapular region) Attacks may be ppted. by fatty food and last <6h. O/e may be tenderness in right hypochondrium. Jaundice if stones passes in to cbd. Same work up as cholecystitis as may be difficult to differentiate clinically. Bloods: fbc, u+e, amylase, lfts, g+s, clotting, crp. If dilated ducts seen on us mrcp. High recurrence rate surgical rx favoured. Loss of terminal ileum ( bile salts) In the gallbladder: biliary colic, acute cholecystitis empyema, chronic cholecytsitis, mucocele, carcinoma, mirizzi"s syndrome. In the cbd: obstructive jaundice, pancreatitis, cholangitis. Stone or sludge impaction in hartmann"s pouch. Chemical and / or bacterial inflammation. Sequelae: resolution recurrence, gangrene and rarely perforation, chronic cholecystitis, empyema. 2 fingers over the gb and ask pt. to breath in. Hida cholescintigraphy: shows failure of gb filling (requires functioning liver)
